Your Guide To Mastering the Art of Patient Presentations During Clinical Clerkships

Clinical clerkships represent your transition from the classroom to the front lines of patient care. Central to this experience is the art and science of patient presentations—a skill that not only communicates the patient’s condition but also reflects your depth of knowledge, critical thinking, and ability to collaborate with the healthcare team. In this article, we delve into the process of mastering patient presentations during clinical clerkships, addressing basic questions like: What is a clinical presentation? How do you present a clinical case? What differentiates presentations in outpatient clinics from those in hospital settings? What essential components should be included in a patient case presentation? And, perhaps most importantly, how can you hone your skills to become an expert presenter?

What is a Clinical Patient Presentation?

A clinical presentation is a structured communication of a patient’s history, physical examination findings, relevant diagnostic data, and treatment plan data to fellow healthcare professionals. It serves as a comprehensive snapshot of the patient’s current medical status, aiding in effective communication among members of the healthcare team. A well-executed clinical presentation not only conveys the patient’s story, but also helps guide clinical decision-making, ensuring that all relevant information is considered in the formulation of a care plan.

How Do You Present a Clinical Case?

Presenting a clinical case involves a systematic approach that ensures clarity, efficiency, and relevance. There are many different types of presentations, however two distinct formats stand out: the complete History and Physical (H&P) and the SOAP style.

History and Physical (H&P) Patient Presentations

The complete H&P presentation is more typically used in the inpatient setting when meeting a patient for the first time at admission. This presentation follows a traditional structure, providing a comprehensive narrative that begins with a detailed patient history and flows seamlessly into a thorough physical examination. This format aims to capture the richness of the patient’s clinical background, including the onset and progression of symptoms, relevant medical history, and comprehensive findings from the physical examination. This type of presentation is typically the longest given on rounds.

SOAP Style Patient Presentations

On the other hand, the SOAP style, an acronym for Subjective, Objective, Assessment, and Plan, adopts a more concise and focused approach. The SOAP format divides the presentation into distinct sections, starting with the patient’s subjective experience, followed by objective data such as physical examination and laboratory findings, then an assessment of the patient’s current medical status, and concluding with a plan for further evaluation and management. While the complete H&P provides a narrative that mirrors the chronological unfolding of a patient encounter, the SOAP style offers a structured and segmented framework, streamlining information for a more targeted and organized presentation. The choice between these styles often depends on the context, the audience, and the specific clinical scenario being addressed.

We highly recommend asking your resident or attending the style of presentation they expect on rounds. While it may feel awkward, it will make rounds more efficient as your peers will be getting the information they desire, in a format they prefer.

Step-by-Step Guide to Crafting a Compelling Patient Presentation

Here is a step-by-step guide to crafting a compelling patient presentation. Note, that depending on the specific scenario, you will NOT include all of the information below:

Introduction:

Begin with a concise introduction, including the patient’s name, age, gender, and relevant demographic information.

Chief Complaint:

Identify the patient’s primary concern or reason for seeking medical attention in their own words (“cough”, “chest pain”). Provide a brief overview of the chief complaint to set the stage for the presentation.

History of Present Illness (HPI):

Present a chronological account of the patient’s symptoms, including the onset, duration, progression, and any associated factors. Include pertinent negatives—information about symptoms or events that did not occur.

Review of Systems (ROS):

Present a systematic review of the patient’s symptoms across various organ systems. Highlight any additional symptoms that may not have been covered in the HPI (often this section follows or is incorporated into the HPI).

Past Medical History (PMH):

Summarize the patient’s pre-existing medical conditions, chronic illnesses, and relevant surgical history. Include information about allergies and any previous hospitalizations. Often, some people will include an abbreviated version of this information in the introduction.

Medications:

List and briefly describe the patient’s current medications, including dosage and frequency. Highlight any recent changes or adjustments to the medication regimen. Include any new medications and supplements.

Social History:

Provide an overview of the patient’s lifestyle, including habits such as smoking, alcohol consumption, recent travel, sick contacts, and recreational drug use. Discuss the patient’s occupation, living situation, and support system.

Family History:

Briefly mention relevant medical conditions present in the patient’s immediate family. Focus on conditions that may have a genetic or hereditary component.

Physical Examination Findings:

Summarize the pertinent findings from the physical examination. Use precise and descriptive language to convey the patient’s clinical status.

Diagnostic Studies:

Include relevant laboratory results, imaging studies, or other diagnostic tests. Provide a brief interpretation of key findings and their implications for the patient’s condition. Of note, you will fully interpret the diagnostic studies in your assessment and plan.

Assessment and Plan:

Offer a concise assessment of the patient’s current medical status. Propose a clear and evidence-based plan for further evaluation and management. Often, the A&P is given in bullet point format organized by the problem.

Narrowing Down Information for SOAP Style Presentations

Every presentation you give as a medical student should NOT have all of the information above. The only time you would mention all of this information would be in the initial H&P. Subsequent presentations should be in the SOAP format. Specifically;

Subjective (S):

This section captures the patient’s subjective experience and self-reported symptoms. It includes details about the patient’s onset and duration of symptoms, associated factors, and any changes since the last encounter.

Objective (O):

The Objective section focuses on measurable and observable data obtained through clinical assessments, physical examinations, vital signs, diagnostic tests, laboratory results, imaging results, and any other objective data that contribute to a comprehensive understanding of the patient’s current health status.

Assessment (A):

The Assessment section synthesizes the subjective and objective information to formulate a clinical impression or diagnosis. It involves a concise summary of the patient’s medical condition and highlighting relevant findings. The assessment may include differential diagnoses and considerations for further evaluation.

Plan (P):

The Plan section outlines the proposed course of action for managing the patient’s condition. It includes short-term and long-term goals, treatment options, medications, interventions, diagnostic testing, consults, and any follow-up plans. The plan also considers patient education, counseling, and coordination of care with other healthcare providers or specialists.

How Do You Present a Patient in a Clinic vs. in the Hospital?

While the fundamental structure of a patient presentation remains consistent, there are nuanced differences between presenting in outpatient clinics and hospital settings. Understanding these distinctions enhances the effectiveness of communication within each context.

Presenting in the Outpatient Clinic:

In general, outpatient clinics are extremely busy and are not conducive to lengthy visits. As a result, be efficient and focused. Many patients will have fifteen problems in their past medical history – you will NOT be able to address all of them in one visit. It is your job to think about what the MOST IMPORTANT medical issues are to discuss with the patient and attending.

• Focused Chief Complaint: Emphasize the primary reason for the patient’s outpatient visit. Tailor the presentation to address the specific concerns prompting the clinic visit.
• Less Emphasis on Acuity: In outpatient settings (except urgent care), where patients often present with chronic or stable conditions, focus on the highest priority chronic conditions the patient has.
• Preventive Care Opportunities: Explore opportunities for preventive care, such as vaccinations, screenings, and health maintenance.
• Discuss lifestyle modifications and health promotion strategies.

Presenting in the Hospital:

While still busy, hospitals afford you a bit more time for your presentation and thus should be more thorough. During your first H&P presentation, you should address all pertinent medical problems, and subsequent SOAP-style presentations can address one to three major problems that are actively changing. 

• Comprehensive Review of Acute Issues: In the hospital setting, place a heightened emphasis on acute changes in the patient’s condition. Clearly communicate any deterioration or improvement since admission.
• Timeliness and Urgency: Hospital presentations often require a more urgent tone, emphasizing critical findings and time-sensitive interventions. Prioritize information based on its relevance to the current clinical status.
• Interdisciplinary Collaboration: Highlight collaboration with other healthcare professionals, such as nurses, specialists, and therapists. Discuss any consultations or interventions involving multiple members of the healthcare team.
• Transitions of Care: Discuss the patient’s progress toward discharge and plans for follow-up care. Address any outstanding issues that require attention before discharge.

How Do You Get Better at Patient Presentations?

Becoming proficient at presenting patients is an evolving process that requires intentional practice, feedback, and a commitment to continuous improvement. Remember that there is no one correct way to present a patient! You may get conflicting feedback from different team members and this is normal. You will develop your own presentation style with time. But importantly, accept everyone’s feedback and do not take anything personally – nobody excelled at presentations on their first try, it requires a lot of practice!

Here are strategies to enhance your patient presentation skills:

Active Participation in Rounds:

Engage actively in clinical rounds, where you can observe experienced clinicians and learn from their presentation styles. Pay attention to how senior colleagues organize information and communicate effectively. Also, listen to other medical student’s presentations, even on patients that you are not following. This is a great way for you to stay engaged if you are feeling tired or if rounds are going on for a long time!

Seek Feedback:

Solicit feedback from preceptors, attending physicians, and colleagues. A great time to do this is at the end of the week before the weekend. Actively incorporate constructive feedback into your subsequent presentations to address areas of improvement. Do not be afraid to ask for feedback!

Practice Regularly:

Practice patient presentations regularly, either with peers or in front of a mirror. Focus on refining your delivery, ensuring clarity, and eliminating unnecessary details.

Utilize Structured Templates:

Use structured templates or mnemonics to organize your presentations systematically. This helps ensure that you consistently cover all essential components and maintain a logical flow.

Learn from Mistakes:

Embrace mistakes as opportunities for learning and growth. Analyze any challenges or missteps in your presentations, and actively work to address them in subsequent encounters.

Stay Informed:

Stay updated on relevant clinical guidelines, evidence-based practices, and the latest medical literature. This knowledge enhances your ability to critically analyze cases and contribute to informed decision-making.

Cultivate Active Listening Skills:

Actively listen to patients and incorporate their perspectives into your presentations. This not only enriches your understanding of the case but also fosters patient-centered care.

Stay Calm Under Pressure:

Develop the ability to present cases confidently even in high-pressure situations. Practice maintaining composure, especially when faced with unexpected questions or challenges. You will often get “pimped”, or asked many questions, on rounds – do not worry! It is okay if you do not know something. Again, do not take it personally, view these challenges as learning opportunities.

Mastering the art of patient presentations during clinical clerkships requires continuous refinement, marked by intentional practice, receptivity to feedback, and a commitment to learning. The ability to effectively communicate a patient’s story is not only a fundamental skill for medical professionals but also a reflection of the clinician’s dedication to providing comprehensive care.

As medical students, honing your presentation skills becomes a transformative process that contributes not only to your professional development but also to the quality of healthcare delivery. By embracing the nuances of presenting cases in different clinical settings, understanding the essential components of a patient case presentation, and actively working to improve their skills, you can position yourself to excel in the dynamic and collaborative world of medicine.

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